What to Watch for in Workers’ Compensation in 2019

Value-based care, political party changes in several states, and a more holistic view of patient injuries will impact the workers’ compensation industry this year, according to two experts hosting a workers’ compensation webinar series, Out Front Ideas.

Mark Walls, vice president for communications and strategic analysis with Safety National, and Kimberly George, chief healthcare officer for Sedgwick, kicked off the new year with a webinar on “20 Issues to Watch in 2019” in workers’ compensation.

George said to expect continuing healthcare discussions now that the constitutionality of the Affordable Care Act (ACA) is under renewed court scrutiny. States will continue to expand Medicare programs with a focus on addressing costs of prescription costs, she added.

“Big pharma is bracing for smaller, but significant, regulatory changes,” George said.

She also believes there will be greater focus on value-based care – with the goal of improving health outcomes and quality of care.

Walls believes the elections in 2018 may have a “big impact” on the workers’ compensation landscape going forward. He noted that gubernatorial changes took place in eight states – Alaska, Illinois, Kansas, Maine, Michigan, Nevada, New Mexico and Wisconsin, and this means new regulators and administrative law judges could decide workers’ compensation practices in individual states.

In addition, he thinks the industry could see legislative changes resulting from the six states (Democrats: California, Alabama, Illinois, Mississippi and Florida. Republicans: Alaska) where one party has total control of the governorship and both legislative branches.

“I would put all of these states on the watch list for potential workers’ compensation legislation,” Walls said.

With the American Medical Association sixth edition guidelines to consider, Walls said states will need to address whether subjective factors should be considered in permanent impairment ratings.

Perhaps the most pervasive trend to watch is the overarching focus on injured employees, not only in the customer service sense, but also in terms of offering personalized experiences, with stakeholders increasingly viewing injured workers as consumers instead of claimants.

George said there will be moves to include the voice of injured workers in the handling of their claims.

In addition, there will be increased focus on the social determinants of health, she said. The impact of loneliness, safe housing, employment and transportation concerns on a patient’s ability to heal and return to work will be examined. Workers’ comp payors are already addressing these issues by offering meal replacement delivery services post-surgery and offering caregiver services for food preparation and companionship.

The “psychology of pain” refers to the biological, emotional and social factors that impact pain, according to George. When patients focus on pain, studies indicate their pain worsens. She sad employers and claims teams are addressing the issue by introducing a pain philosophy into their programs, including creating pain assessment tools and identifying a pain expert that can consult on more complex cases.

Also, watch for more employers to experiment with employee health models.

“Employee health models are evolving with employer-purchased care, in part, because health insurers are not negotiating and managing costs in a way that employers can do so directly,” said George.

Mega claims, natural disaster planning and dealing with impairment at work related to legalized marijuana are other issues to watch, thy said.